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1346874369
MIKA SOUTHALL
FORT WORTH, TX
NPI
1346874369
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Entity Type
Individual
Gender
Female
Sole Proprietor ?
No
Primary Taxonomy
235Z00000X Speech-Language Pathologist,
(Licence: TX 115249)
Enumeration Date
2020-02-28
Last Update Date
2020-02-28
Business Address
MIKA SOUTHALL SLP
3840 HULEN ST
FORT WORTH, TX 76107-7277
Phone number: 817-335-3022
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Mailing Address
MIKA SOUTHALL SLP
PO BOX 2603
FORT WORTH, TX 76113-2603
Phone number: 817-569-4786
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